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Topics in Evidence-Based Pharmacy Practice
3/15/2011: Metformin: Both Cardio Protective AND Cardio Toxic?
Brittany Martinez
Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas
Tina Lopez
Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas
Excerpt:"The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consider metformin, along with lifestyle changes, to be the cornerstone of pharmacological treatment in patients with type 2 diabetes mellitus (T2DM) and recommend it as first line therapy.1,2 Oral antihyperglycemic agents have shown neither benefit nor increases in cardiovascular risk; however, metformin has been shown to be beneficial in regards to improvements in cardiovascular morbidity and mortality.2,3,4 Pharmacological treatment with metformin in T2DM decreases hepatic glucose production, decreases intestinal glucose absorption, and improves insulin sensitivity; however, it has also been shown to decrease vitamin B-12 and folic acid concentrations while increasing homocysteine concentrations in previous short-term studies.4,5 While decreased vitamin B-12 and folate concentrations can lead to macrocytic anemia, neuropathy, and mental changes, an increased homocysteine concentration is an independent risk factor for cardiovascular disease, especially in T2DM patients.4 Generally, within 8 years of being diagnosed with T2DM, 45% of..."
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